Quality clinical work and devotion to our patients are the very identity of the Yale Psychological Medicine Service. The two primary clinical goals of the Yale Psychological Medicine Service are:
- To prevent, detect, and treat psychiatric co-morbidities of medico-surgical patients to remove behavioral barriers in achieving optimum health.
- To facilitate and advocate for efficient, quality medico-surgical care for the patients with severe mental illness in order to improve their global health through integrated care.
Inpatient Psychiatry Consultation Liaison Services
Inpatient psychiatric consultations to patients with medical and surgical conditions are provided at both New Haven and St Raphael campus.
The Consultation Liaison Psychiatry Service at Yale New Haven Hospital provides psychiatric care to adult patients admitted to medical, surgical and obstetric units of the hospital. This area of psychiatry is also known as psychosomatic medicine.
The service assists with the evaluation and treatment of psychiatric conditions related to medical illness, whether these are physiological, such as delirium related to infection, or psychological, such as emotional reactions to illness. The service also assists in medical conditions related to psychiatric illness, such as anorexia nervosa, or to psychiatric treatment, such as side effects of psychotropic medications. Over 2,000 consultations are seen each year.
The service includes 8 full or part-time faculty attending psychiatrists, as well as fellows, residents, medical students and other trainees.
Active areas of research include methods for identifying and providing appropriate medical health care to hospitalized patients.
Behavioral Intervention Team Section
The Behavioral Intervention Team (BIT) is an innovative model of psychiatric service at Yale New Haven Hospital which involves a dedicated team of psychiatrists, advanced practice nurses, clinical nurse specialists, and clinical social workers. Since its study pilot in 2010, the team now provides psychiatric service to the entire medical service at YNHH York Street Campus.
In the BIT model, patients are screened on a daily basis for psychiatric or behavioral issues. Once patients are identified, BIT clinicians will provide psychiatric intervention (e.g. pharmacotherapy, behavioral plans, etc.) so that acute psychiatric episodes are prevented.
The BIT model also provides support to the primary nursing and medical teams who might otherwise find it difficult to manage the medical condition of patients due to psychiatric comorbidity.
Performance metrics have shown that the BIT model not only reduces the average length of stay of patients but it also has significantly reduced the number of avoidable days or denied days from third party payers and reduced patient sitter utilization requests as a result of quicker psychiatric evaluation of patients.
Currently, there are several hospitals throughout the country that are interested and even visited to learn about BIT and how to implement this kind of psychiatric model in their own institutions.
Transplant Psychiatry Section
Psychiatry has been working closely with the Yale Transplantation Center (YTC) since 2006. Currently the section consists of one psychiatrist, a psychologist, Consultation Liaison Psychiatry fellows, Addiction Psychiatry fellows and psychology fellows. Over 400 patients, potential organ recipients and donors are evaluated every year, both inpatient and outpatient.
Our main goal is to identify and address mental health issues which may interfere with a successful outcome of organ transplantation and assist patients to overcome this major health challenge. Psychopharmacological treatment and/or psychotherapy is provided when appropriate, especially in the peri-operative period when transplant candidates prepare and recover from the transplant surgery. In addition, all living organ donor must undergo a mental health assessment prior to being accepted and undergo surgery.
Our section is fully integrated in the YTC recipient review committees and the living donor committees.
The director of the Transplant Psychiatry Section is Paula Zimbrean, MD who focuses on liver and kidney recipients and donors. Susan Gold-Rubman, PhD, joined the service in 2017 and provides evaluations and psychotherapy to organ transplant candidates and organ donors.
The Interdisciplinary Adult Sickle Cell Program (ASCP)
The program was developed in 2012 to provide high quality, cost-effective care through a comprehensive, multidisciplinary clinical approach for adults with sickle cell disease, in order to shift care away from more expensive and less effective emergency/inpatient services.
The program consists of a program director, hematologists, mental health providers, APRNs, and social workers. Additional targeted resources include a dedicated inpatient unit, as well as care coordination, pharmacy and patient relations staff.
Multiple clinical protocols and interdisciplinary interventions for adults with sickle cell were established by late 2012, including mental health services.
Dr. Ariadna Forray is the Mental Health Director and psychiatric provider for the program. She oversees the mental health services provided by the program, including inpatient consultation, depression, anxiety and substance abuse screening for all patients, and outpatient psychiatric treatment embedded in the hematology clinic.
Behavioral Medicine Program
The Behavioral Medicine program is a psychological consultation and intervention service where the goal is to provide support to medical providers and their patients so that the patient’s emotional and mental health needs can be addressed within the context of their overall medical care.
The service operates under the premise that integrated behavioral medicine has the potential to benefit both patient and physician by improving access to behavioral health care for medically ill individuals.
The Behavioral Medicine service employs evidenced-based treatments to target symptoms of depression, anxiety, stress, and pain, and to address problems related to medication adherence, addictive behavior, and other lifestyle and psychosocial issues effecting wellness and quality of life.
HIV Psychiatry Program
The Nathan Smith Clinic (HIV) Clinic at Yale New Haven Hospital provides comprehensive care to adult patients living with HIV/AIDS, with integrated inpatient and outpatient services, social work, nursing, neurology, gynecology and specialized hepatitis C treatment for the co-infected. The clinic sees approximately 870 patients per year.
Psychiatric consultations have been provided from the inception of the clinic almost 30 years ago. Typically two psychiatrists provide 4 clinics weekly with the support of 3 dedicated mental health social workers.The goal is to have a multidisciplinary mental health approach while tailoring treatment modalities to delicate HIV medication regimens.
Primary Care Psychiatry
The Yale Psychological Medicine Service provides outpatient psychiatry consultation in the primary care setting at the two sites: the Primary Care Center of Yale-New Haven Hospital and St Raphael Campus. With a co-located psychiatrist available in the primary care clinic setting, we strive to provide integrated care to patients with comorbid physical and psychiatric disorders.
We offer consultations to the outpatient Family Practice and Internal Medicine departments. Referrals for consultation often include mood and anxiety disorders within the context of chronic medical conditions. The clinic also offers general psychiatric services to patients of Hispanic heritage who have the option of receiving treatment in their native language.
Importance is placed on assessment, stabilization and management of patients followed by skilled members of a general medical team. Often, the patient continues to receive psychiatric follow up from the primary care clinician after the patient has been seen by the outpatient psychiatry consultant.
In addition to clinical care, psychiatrists are involved in teaching Internal Medicine and Primary Care residents.
Tobacco Treatment Service
Under the direction of Associate Professor of Psychiatry, Dr. Lisa Fucito, the Tobacco Treatment Service at Smilow Cancer Hospital aims to help patients stop the cycle of tobacco use.
Treatment includes includes safe, effective FDA-approved medications such as nicotine replacement therapies (including the patch, gum, lozenge, inhaler, and nasal spray), bupropion SR (Zyban), and varenicline (Chantix) in combination with practical counseling.
Treatment is tailored to fit each patient’s individual situation and tobacco use history.
The Service is comprised of a multidisciplinary team of advanced nurse practitioners, psychologists, physicians, and research staff. Dr. Steven Bernstein, Professor of Emergency Medicine and Public Health, provides expert advice regarding the clinical care of all patients. The patient coordinator schedules all treatment appointments and makes every effort to schedule counseling sessions that coincide with other medical appointments.
St. Raphael's Campus Psychiatric Consultation Service
The Psychiatric Consultation Service at St. Raphael’s Campus consists of two components: a traditional psychiatric consult-liaison service which provides care on most units of the hospital, and a Behavioral Intervention Team (BIT) designated to cover a number of medical units that provides pro-active care by an interdisciplinary treatment team. Both components provide psychiatric evaluation, treatment and, where indicated, referrals to patients admitted to the inpatient units of this campus. All manner of psychiatric and behavioral difficulties are addressed, including the treatment of mood issues arising in the context of medical illness, psychiatric and behavioral disturbances associated with dementia and delirium, and management of patients with underlying psychiatric illness who require hospitalization. Transfer to inpatient psychiatric care is secured when warranted. The service also evaluates decision-making capacity of patients when it is in question. Additionally, the service provides liaison support to hospital caregivers as well as education about psychiatric illness and its management in the medical setting.
The Psychiatric Consultation Service currently is staffed by nearly 2 full-time equivalent psychiatrists as well as two full-time equivalent psychiatric advanced practice registered nurses. In addition, the BIT service has one full-time social worker and a 0.6 FTE clinical nurse specialist. One PGY-2 Yale psychiatry resident and one Yale medical student rotate on the service most of the year.
The Palliative Care Service at Smilow Cancer Hospital
The Palliative Care Service at Smilow Cancer Hospital is dedicated to the care and comfort of seriously ill patients and their families and has been providing comprehensive interdisciplinary care to patients and their families in Connecticut and beyond since October 2007.
Palliative care focuses on symptom and pain management and quality of life issues for adult patients with complex, life-altering and life-threatening illnesses. The program is centered on the patient and their family, and deals with physical issues such as pain, fatigue, and nausea; and with psychosocial issues like depression, disruption of family life, and financial concerns.
The Psychological Medicine Service provides outpatient and inpatient psychological care to patients within the Palliative Care Service. Dr. Dwain Fehon, Chief Psychologist at YNHH, is a member of the Palliative Care team and he provides co-located evidence-based outpatient psychological consultation and intervention to adults living with advanced cancers of all types. Treatments are geared to help patients cope with life-threatening illness, depression, fears of cancer progression, cancer-related pain, addictive behaviors, and existential distress.
Psychology fellows within the Psychological Medicine Service’s Behavioral Medicine placement train within the inpatient Palliative Care consult service and carry a caseload of patients with the outpatient palliative care clinics as well.
Additional educational opportunities in Palliative Care are available through the service’s monthly case conferences, journal clubs and grand rounds presentations.
Yale Center for Sleep Medicine
The Yale Centers for Sleep Medicine in North Haven and Madison, CT offer a coordinated approach to the evaluation, diagnosis, treatment and management of a variety of sleep disorders and related conditions, including excessive sleepiness, insomnia, movement disorders, narcolepsy, parasomnias, restless leg syndrome, circadian rhythm disorders (including delayed sleep phase syndrome and shift-related work disorders), and sleep apnea. The program is accredited by the American Academy of Sleep Medicine.
The team is multidisciplinary and includes physicians from the Yale School of Medicine who are internationally recognized for their expertise in the sleep medicine field. These clinicians are board-certified in sleep medicine in addition to internal medicine, pulmonary disease, neurology and pediatrics. The team also includes physician assistants, nurses, polysomnographic technicians, and a clinical psychologist.
As an interdisciplinary program, clinicians work closely with a network of specialty providers who are board-certified in bariatric surgery, cardiology, dentistry, neurology, and otolaryngology.
The behavioral sleep program is under the direction of Assistant Clinical Professor of Psychiatry, Dr. Lynelle Schneeberg, who is also a Fellow of the American Academy of Sleep Medicine. The behavioral sleep program evaluates and treats patients with chronic insomnia, circadian rhythm disorders, narcolepsy, night eating syndrome, and parasomnias including nightmares. The behavioral sleep program also works with patients who have difficulty with PAP adherence after a diagnosis of Sleep Apnea.
Geriatric and Perioperative Psychiatry Program
The Yale Psychological Medicine Service provides outpatient psychiatry consultation to the Geriatric Medicine team at the Dorothy Adler Geriatric Assessment Center. Referrals for consultation often include cognitive and non-cognitive behavioral symptoms within the context of geriatric syndromes such as dementia and/or delirium. We offer consultations to any elderly patient referred by any primary care and specialty services. Special emphasis is placed on the assessment and care of elderly patients who are about to face a major surgery or have developed neuropsychiatric symptoms after surgery.